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Author
Topic: Recommendations For HIV Drugs (Read 7273 times)

Background: I have been poz for almost 7 years now. My viral load is around 3k, and CD4 count is over 500. The % is low which is under 17%, which is why I am planning/thinking to go on meds soon depending on next set of results. My next blood drawn for that is going to be by the end of December when I/my doc will be making a decision based on the results.

Information: I am doing my research now (of course drug resistance testing is yet to be done). I want to find out from you guys what are my options. So far, Atripla is top of my list due to lesser side effects, coherent to adherence issues etc. I have heard that Sustiva is one of the components in Atripla that doesn't suite with someone who has depression problem. I was severely depressed for couple years after my diagnosis and I may be am still depressed (I have an appointment set up with a psychiatrist this month on that). So, I am not sure how that will play into when I select Atripla. I have heard few things about Complera but some people mentioned about few side effects that I am taken back with.

Question: I understand every HIV drugs works differently for everyone just like the virus. My options includes pretty much what everyone wants - lesser side effects, possibly once a day pill. Can anyone suggest any drugs that worked for him or her?

Any comments/recommendations will be helpful for someone who is a treatment naive like myself.

Due to your low viral load you would be a candidate for Complera however, it is not totally side effect free (a few have spoken of mood problems) and there are some minor issues with ensuring you take it with a meal and avoid certain anti heartburn medicines.

Atripla, is a workhorse (in my opinion) but not without its side effects (well known).

The PI's seem to have less side effects (particularly Prezista) but its 3 or 4 pills (still just once a day so really of no significance).

Isentress would be my choice after Atripla (but its twice a day).

If you have the time you may want to consider the Quad Pill due to be approved in 2012. Its one pill a day. Not sure about side effects though since its so new.

Atripla - Well known side effects for Atripla that I am aware of are; Woodys, vivid dreams, dizziness, and anger issue ( due to Sustiva ) unless some other effects that I am not aware of.Quad Pill - I may be able to wait till 2012 for Quad Pill but I think I would be skeptical to try that out first without knowing the side effects from othersComplera Ė I was really hoping to hear about this med to have fewer side effects, but, I guess we still have time to find out.

I would really love to try one pill once a day but if some combo is really great and has lesser side effects then I guess, I will compromise.

So far Atripla is great if I could work out the sustiva part ( due to my past depression problem etc).

It will be nice to know from others too whatís working for them and how they are dealing with it Ė Thatís where my research/get to know from others part comes from.

The side effects from the Sustiva portion of Atripla cannot be overstated.

If you have ANY history - personal or family - of depression, you must be monitored very carefully to avoid rage and/or suicidal ideation. Often, these side effects do not fully manifest until months after treatment begins, long after the benign effects (vivid dreams, sleep disturbance) have worn off.

If you have a history, personal OR familiar, that involves major depression, PLEASE mention that to your doctor. People have killed themselves on Sustiva, a fact that went horrifically unreported when it was first brought to market, and a fact that I fear is still being minimized even on these forums.

Don't get me wrong. Those for whom it works, it works wonders. It crosses the blood/brain barrier and controls HIV like a total champ. And for those without a tendency towards depression or rage issues, it presents NO PROBLEM at all.

But I fear, especially given a few recent events, that we as a forum have not been as forthcoming about the severity of the psychotropic impact as we ought. This can isolate and ostracize people who DO end up, even after weeks or months, having a terrible cumulative reaction to the drug. I do not wish to sing unadulterated praise to a drug that works fine 75% of the time, when it means ignoring - or worse, dismissing - the 25% who simply cannot tolerate the effects.

I was one of those people. I was fine for about three months, vivid dreams and all. And I could not tell you exactly when the suicidal thoughts started. But they did, and it came to a breaking point that, had it not been for my own fortitude in firing a doctor who was unaware of these effects (thanks to the pharma company) and finding an alternative, I know for a fact I would not be here today.

Say what you want about their amazing efficacy. And it is indeed that. But these drugs are powerful as shit. And little enough is understood about brain chemistry. That which enters your CSN will have unintended impact. For the lucky majority (it would seem) that impact is slight. But DO NOT hesitate to seek help if rage and/or suicidal thoughts creep in.

I know we all want to sing the "AIDS is Over" song. The "one pill, no waiting" song. I do too. But one size, just like HIV, does not fit all.

« Last Edit: December 05, 2011, 05:47:03 AM by jkinatl2 »

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"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

At first the once a day seemed a no-benefit to me and I did not list it as a must have; but, really it makes life easier

Viramune XR and truvada (or less common Viramune XR and epzicom) it a once daily (2 pills) alternative if you fears EFV might be too strong for you (indeed 20 to 25% drop out of Atripla within a year, due to the CNS)

For those, who like me take their meds in the morning, once it is done, they do not have do bother about it.

Unless a night out of home is planned (or unplanned) I do not have to bother about carrying pills (eventhough I do, most of times ,but that is just in case)

I can only repeat what others said: Be careful with atripla; it's a nasty drug: There are better pills on the market.

Sorry, Matts, I can't see where people have labeled Atripla as a "nasty drug." For those without the CNS side effects of the Sustiva portion it is a true miracle one pill a day wonder.

Like most potent forms of chemotherapy, it is a remarkably powerful and effective series of drugs rolled into an incredibly easy to take pill - with enough caveats worth mentioning, and mentioning often enough to cause concern. That does not make Atripla, specifically the Sustiva portion of it, "nasty."

Trust me, I have seen nasty drugs.

Logged

"Many people, especially in the gay community, turn to oral sex as a safer alternative in the age of AIDS. And with HIV rates rising, people need to remember that oral sex is safer sex. It's a reasonable alternative."

I can only repeat what others said: Be careful with atripla; it's a nasty drug: There are better pills on the market.

1. No one else said Atripla is a nasty drug. 2. As far as better pills on the market, only Isentress has been shown in clinical trials to meet or exceed Atripla in efficacy. Why do you think all new drugs are tested against Atripla? Its because until now nothing has been shown to work better.

I am not discounting the small number of people that have a problem with Atripla. However, the majority of people on it do quite well.

You could say it's "nasty" in the sense that the vile side effects effect a greater percentage of patients when compared to other first line recommended HIV meds, and that because it's by far the most widely prescribed medication in the US and other developed countries the raw numbers experiencing CNS side effects is exceptionally large.

Add to that the large numbers of doctors who do not adequately caution patients about what may happen, nor screen them properly for pre-existing mental health issues, and sure -- 5 years down the road we'll all look back and ask why the "one pill a day" issue over-rided taking something twice a day and having less propensity for harsh side effects. Actually I've always looked at it that way.

As far as Atripla being a "miracle drug" what's up with that? Aren't all other first line recommended HIV medications? They all work in a properly prescribed regimen. In fact if anything it seems that it's Atripla patients (just some of them) that seem to take longer to get HIV to an undetectable level. There have been more than a handful of studies that show if a patient's cd4 count is in "x" range (I forget what "x" is) then a PI-based regimen will suppress the virus more effectively, meaning quicker, and perhaps with a larger cd4 increase. If the goal is that then I don't know why a PI-based regimen isn't utilized more, even if it means switching to the more convenient once-a-day regimen down the road.

But hey, everyone wants life to be like instant Jell-O and have that one-pill-a-day.

Atripla is not a miracle drug (didn't mean to imply). In fact it does take longer to reach UD on Atripla than some other drugs (Isentress drops a viral load quite quickly).

As far as PI's i think the sheer number of pills (albeit you take them all at once) makes some people hesitant. Also, the norvir booster makes some hesitant (I would think twice due to the norvir, I'd still take a PI though).

Also for those who may not be 100% adherent, a PI regiment such as Reyataz would be the preferred option because those who fail on Reyataz develop the least amount of resistance.

I heard a presentation Dr Gallant from Johns Hopkins gave to an HIV clinic here in Seattle about whyc choose one first line regiment over another. He listed the pros and cons of each. It was very interesting and I learned a lot and quite a bit of new info (for me). Its on the web, ill try and find the link and post it.

fyi, in phase 3 trials the new norvir alternative Cobicistat was shown to have similar side effect propensity, so that's a wash. IMO people are timid about norvir because of old stories from patients that took it as a singular PI a decade or longer ago, when the dose was much higher. However, the thinking is that it has an advantage over norvir in terms of fat cell accumulation but the data has only been seen in test tubes, but still encouraging.

We predicted that the dominant mechanism for the 70% reduction in the second-phase viraemia is not antiviral efficacy but the stage of the HIV viral life cycle at which raltegravir acts.

and

...the viral dynamics produced by different antiretroviral drugs should not be directly compared with each other.

(the emphasis on is not antiviral efficacy was added by me for clarity)

In otherwords, the faster decay of free viral load observed in blood test, when raltegravir is used should not be interpreted as a better efficacy

I do not think that this adds to the OPs question , but hope this authoritative article can help understand why raltegravir is not considered as superior

as for why clinical test are testing non inferiority to EFV, does not show that EFV is the best. this is historical. At one time it was the benchmark, standing out as the golden standard. EFV just happenned to be the first one to be that potent.

Viramune also crosses the blood/brain barrier, and personally (along with Truvada) has been a absolute breeze for me.

No terrible side effects whatsoever, 2 pills (once my original Viramune runs out and I get the XR version) once a day.

Of course there is caution and close monitoring required initally with Viramune due to the potential liver toxicity issues. Perhaps this put's some Dr's offside or hesitant?

Viramune seems to be percieved as an "old" drug by some (well, it is fairly "old" 1996 I believe it was first used, or around then...) , ...just my 2 cents worth.....

Cheers.....

Edited to add : Also, no food restrictions with this combo which can make life just a little bit easier for those of us who have irregular meal times etc as most of you already know, and another thing personally, it's a non PI based regimen. The PI's I started on (reyataz/norvir) played havoc with my guts, so changing to a non PI combo (after becoming U/D) was a blessing for me...

The fact remains that while raltegravir may have interesting biochemical properties to inform mathematical models of viral decay, in real people it drops viral load as measured in blood (the key clinical measure at present) more quickly than efavirenz. Whether this is clinically important to most people is moot (probably ain't in most cases). I reckon any doc these days wanting a quick reduction in viral load for a specific reason would reach for raltegravir. Also, with due deference to Dr Siliciano et al's very good paper, raltegravir is used with 2 nukes so the life cycle arguments are perhaps nil in real life. And a recent report shows that over 4 years raltegravir outperforms efavirenz on several measures.

I conclude, raltegravir is a more effective drug. But it is really, still a 2 x day drug and efavirenz is 1 x day.

@Newt Ė About your comments ďraltegravir is a more effective drug. But it is really, still a 2 x day drug and efavirenz is 1 x day.Ē When it comes down to 2wice a day, I would rather do it for 1 * day unless former outperforms the later. As you said if anyone needs a quick drop on VL then doc would/may suggest raltegravir, I am not sure I personally would need that but your points on the outperforming measurements against efavirenz, I will have to focus on that. Again, that also depends on the drug resistance test results. Thanks for sharing the info.

@Erick - Yes you are right. I still have to do the drug resistance testing. I like the fact that Viramune has been beneficial in term of depression/stress etc. related facts, however, as it was mentioned in your thread/by your doc it is not usually recommended if one has CD4 more above 400. I know yours was 440 but mine is above 500 (until now). Should I not still be moot on this then?

BTW, I loved reading your thread/link you provided and wanted to know are you in love with your doc? (Just kidding).

@Pozoz Ė Thanks for info on Viramune. I also like the idea of that it became a once a pill a day. But like I said I have to think and talk with my doc about the cd4 count barrier.

@Miss P Ė I agree with what you said ďBut hey, everyone wants life to be like instant Jell-O and have that one-pill-a-day.Ē Life will be little easier if that does work.

@Buginme - I wish I did not have the depression problems in the past otherwise, I agree, Atripla is the best choice for some

@jkinatl2 Ė I liked the adherence part of the Atripla as I am forgetful with things and it seems like this may work if I would work out the sustiva portion of it. thanks for your input.

I have to be honest. Searching for drugs is a bit confusing or should I say lots of info/drugs to choose from. Besides the above said drugs I have complera and Quad Pill ( coming 2012) for thoughts. However, it is good. I am kinda like you guys.. I would rather make an informed decision and be an active patient with the doc. Before anything though, I would still need to do the resistance testing and that is another huddle to overcome before I make a choice. Thanks again for sharing your ideas/suggestions/comments.

Thanks Matt, how many pills? what are the side effecfs? I didn't have any depression problems for years (it happend right after my HIV diagonsis) but now, I may be am slightly depressed but we will see. I am not counting the sustiva portion completely out unless I talk with the doc.

Why did you call Atripla a nasty drugs? I have heard good things about it but not about sustiva portion.

Thanks for the suggestion.. I will put that on my list after my resistance test and getting more info on side effects etc.

I conclude, raltegravir is a more effective drug. But it is really, still a 2 x day drug and efavirenz is 1 x day.

- matt

Hi Matt,

I have a question. Does Efavirenz contains sustiva? Now, if anyone like me has past depression problems ( I think mine is more situational than chemical meaning I was depressed severely for two and half years after HIV diagnosis and now I may be slightly depressed ( doc gave me an optional choice to me on meds for that). The question is if one takes Efavirenz which constains sustiva(?), would be still okay as far as side effects goes if that parson have past depression problems. I do understand that you mentioned raltegravir is more effective but I was more thinking about the convenience part of Efavirenz.

Efavirenz and Sustiva are the same drug (Sustiva is just the brand name). The question of will Sustiva (or Atripla for that matter) cause depression in you is difficult to answer. It affects different people, differently.

It has caused zero depression symptoms with me. You may be different. Isentress has less CNS side effects overall.

Is anyone on Reyataz boosted with Norvir plus Truvada? This is I believe once-a-day combo? I have heard that some got good results with this. Can anyone tell me how this combo works out for him/her? any issues etc?

Thanks much

Since2005

Edited to ask: Is there any link or chart of meds for efficacy and side effects that one can look at for all the major/recent/1st class so to speak (mostly once or twice a day pills) for a quick view? I am trying to look for it but I haven't been able to find one yet...

Is anyone on Reyataz boosted with Norvir plus Truvada? This is I believe once-a-day combo? I have heard that some got good results with this. Can anyone tell me how this combo works out for him/her? any issues etc?

Thanks much

Since2005

Edited to ask: Is there any link or chart of meds for efficacy and side effects that one can look at for all the major/recent/1st class so to speak (mostly once or twice a day pills) for a quick view? I am trying to look for it but I haven't been able to find one yet...

While there are many lists of possible side effects, except for sustiva many folks who are starting on today's meds don't wind up with enough of a side effect to significantly interfere with their lives. Just reading the posts on here may give you a biased view, since those of us who have side effects that get in the way tend to stick around and post more often. But there is no guarantee that you will get any side effects at all. And if you get one you can't live with, there is little penalty in trying another combo.

There was a time when there were few options and dosing and resistance were not well understood. That time has passed. As long as you maintain adherence and change smoothly from one drug to the next, if you don't like the first set of drugs you should be able to change to a new set without losing any options.

So just start a combo and if it seriously gets in your way, change it.

Given that you've said you have a history of CNS issues, though, I'd probably stay away from Atripla on the first round and perhaps Complera as well.

While there are many lists of possible side effects, except for sustiva many folks who are starting on today's meds don't wind up with enough of a side effect to significantly interfere with their lives. Just reading the posts on here may give you a biased view, since those of us who have side effects that get in the way tend to stick around and post more often. But there is no guarantee that you will get any side effects at all. And if you get one you can't live with, there is little penalty in trying another combo.

There was a time when there were few options and dosing and resistance were not well understood. That time has passed. As long as you maintain adherence and change smoothly from one drug to the next, if you don't like the first set of drugs you should be able to change to a new set without losing any options.

So just start a combo and if it seriously gets in your way, change it.

Given that you've said you have a history of CNS issues, though, I'd probably stay away from Atripla on the first round and perhaps Complera as well.

Best to youA

Thanks for the link! I have a doc visit coming up next week and we will take it from there..

I am actually writing this as a reminder for myself. So, I could go back and check what my numbers were if I need to My current and previous immune status:

Infected with HIV in Feb/March of 2005

1st lab result 8/2011 CD4: 564VL: 2953CD4%: 25%

2nd lab result 10/2011CD4: 517VL: 3008CD4%: 16.9%

3rd lab Results in 01/2012VL : around 3k/3k+CD4 : 429CD4% : 19.1%

Some just Okay news:

By the third lab results, I can see my viral load is pretty consistent around 3k. My CD4 is slowly decreasing. Not too concerned about CD4 as it could be +/- 150 for any given day. It has decreased over 6 moths by 135. As for CD4 %, I am concerned about that it's a decrease of about 6% over 6 months. So lets say about 1% each month. It doesn't sound too bad though borderline is at 14% and I am not too far from it.

My doc says, ' You donít need to take meds now or before thanksgiving but I canít say you wonít take if for another 5 years or 10 years, Keep monitoring'. Hope, my percentage gets improved though. Lets just wait another 4 months or so and see what happens!

Some good news:

Drug resistance testing is done Ė No resistance found . Yeaaaa.. that's a relief. So, my doc will have me go back there again in May,2012. By then, I will have four lab results and we will definitely find a trend. But, I am very very glad about the genotype test results. May be, I will be taking Quad pill after all. I will wait.

No anal precancerous cell. There was some abnormality in level 1 type. So, I had a procedure done. The specialist mentioned that it gets fixed by itself and no need to go back for another check up till about a year or so.

Some not so good news but really not alarming:

Cholesterol 213 Ė Reduce eating eggs. Total Cholesterol level in normal range is between 200 and 230. Goal is to get down to under 200. He did mention that 80% is generic and 20% is controllable. Diet (watch what one eats) and cardiovascular activities ( running, jogging ,walking) should do the trick. I will have another check up in May.

Vitamin D deficiency level is 13 where for a normal person number should be between 10 (lower) to 30 (normal). The goal is get over 30 ng/ml(?). That tells me why would I have some discoloration on my elbows (a little bit). Well another check up is due in May, better take some damn supplements right away. Doc wanted me take some 2000 IU daily. You can get those from over the counter.

Some concerns that I have overall is :

I have been exposed to some bacterial infection my face and butt. it was more like 3 times in 2 months period. Reoccurring kinda situation. This time doc had me put 20 days antibiotic course, wanted me to use anti bacterial soap for a month and anti antibiotic for 10 days (I believe 2wice a day, nasal drop) after 20 days are done to avoid colonization.

Overall, I am not stressed out. Syphilis test was negative ( I had syphilis 7 years ago and that's how I found out dx for HIV). So, it's a relief for now. No Hep C - Negative, Hep A/B can't remember, for that, I taken 2 shots and I would have to take another one sometime this year ( I will put this on my note to ask my doc). kidneys etc. all good. So, I am happy.

At least, I got some answers about the discoloration of my skin. Vitamin D Deficiency, who would have thought. I am darker skinned, but doc said that doesn't mean anything. I am pretty positive it has something to do with HIV. I never had the discoloration before. Again, I never tested my vitamin deficiency level prior to HIV dx either. So, who knows. We do hear a lot about Vitamin D deficiency level as HIV related issues if I am not mistaken.

So, I would ask if anyone has any experiences about bacterial infections, vitamin D deficiency situation, what level etc. and what was recommended... Any other recommendations for HIV meds besides the ones we talked about in this thread...

up until 2005, I was very sick, hospitalized several times, took a ton of meds, and had the AIDS for 15+ years. My chart of VL and CD4 was pretty whacko those years.

Around the end of 2004 I finally got a regimen that worked and didn't make me puke. (reyataz, norvir, truvada) Sometime in 2005, for the first time I actually hit undetectable and then after a handful of blips it finally settled down and stayed UD. During the same time period, my cd4s finally got over 200 and began the long struggle up to the very low 300s.

by narrowing down the time range and only looking at the viral load it was easy to see the blips from 2004-2007 until the viral load stablized at UD

so I have continued plugging in the numbers after 2005, but without being at death's door with the AIDS, the graph has calmed down to a nice steady UD viral load and a gently upwardly mobile cd4 count.

it's just a shame that I don't have numbers from early 1992 when I was dx'ed but they didn't even have a viral load test until 1996 when I was in the hospital for the first time. But numbers going clear back 28 years ago to 1984 when I was infected would really be awesome. LOL

Whats up 2005? I've been reading posts but haven't really participated until reading yours. I was diagnosed last year (2011), and after months of trying to avoid going on meds because my insurance doesnt cover brand name meds, I joined a clinical trial for the Quad pill. I've been on it for 5 days now and I have to say I have no side effects so far (except mild grogginess in the morning.. it takes 10 minutes to get out of bed). Apart from that.... I feel perfectly fine. I know its been only 5 days but I feel very fortunate to be on an one pill, integrase inhibitor (like Isentress) based regimen. If you're worried about the psychiatric side effects of Atripla and want to a one pill a day, then I would wait a few months and see how you do on this one. Previous studies have already shown that it is more potent than Atripla (90% achieve undetectable within 6 months of starting), and has far fewer side effects (especially psych) than Atripla. I'm just telling you my experience so far, but its up to you and your Doc to decide whats right for you.. It could be worth waiting for a few months. Good luck!

My experience with Atripla was absolutely horrible. It severely affected my depression and anxiety, and I thought my life was over if I was going to have to take pills that affected me like that for the rest of my life. However, no one else I know has any problems with it. Just know that if you try it, and you find the side effects troublesome, you can change to something else. And you may have no side effects from it at all. Now I take Prezista, Truvada and Norvir with no side effects at all. It's a total of 4 pills a day, but that is not an issue with me. Best of luck to you.

I have been on Reyataz, Norvir and Truvada as a first line regimen since 2007. This regimen was with no side effects from day 1. Now I am looking to change out my Truvada since my osteopenia worsened. Truvada has been linked to osteoporosis.

I have been on Reyataz, Norvir and Truvada as a first line regimen since 2007. This regimen was with no side effects from day 1. Now I am looking to change out my Truvada since my osteopenia worsened. Truvada has been linked to osteoporosis.